Fall League Fall League Registration Form 1Registration2Payment Fall League Options - Choose one* $225 - Wednesdays & Sundays (Middle & High School Ages) $120 - Wednesdays or Sundays (Middle & High School Ages) $120 - Wednesdays & Sundays (Middle School September Only) $70 - Wednesdays or Sundays only Total Price Price: $0.00 Are you registering as part of a team?* Yes No Team Name* Are you an Eclipse player?* Yes No How did you learn about the camp?* CAMPER INFORMATIONPlease complete the following information about the camper you are registering.Name* First Last Date of Birth* MM slash DD slash YYYY Age* Grade* High School Graduation Year*Height* Weight* Jersey Size*Youth XLSmallMediumLargeXLAll jerseys are in Women's sizes.PARENT/GUARDIAN INFORMATIONPlease complete the following information about the parent/guardian of the camper you are registering.Name* First Last Email* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code EMERGENCY CONTACT INFORMATIONWho should we contact in the event of an emergency?Name* First Last Phone*LIABILITY RELEASE AND WAIVER/ PARENTAL CONSENT FORM & MEDICAL RELEASE*I understand that the facility is not sponsoring the JL Hoops Factory Fall League in which I am participating. I acknowledge and agree that participation is strictly voluntary and between the league sponsor and myself. I further acknowledge and agree that while attending these leagues and traveling to and from these leagues there is the potential for accidents to occur. I for myself, my heirs, executors, administrator and anyone else who may claim on my behalf, covenant not to sue and WAIVE, RELEASE AND DISCHARGE the facility, its officers, director, agents, employees, representatives and successors, for any and all claims or liability, whether foreseen or unforeseen, for personal injury or property damage directly or indirectly arising out of, or in the course of, my participation in the camps or leagues. I acknowledge that there are risks, known and unknown, related to COVID-19 involved with the Minor’s participation in the Event. These risks include exposure to or infection from COVID-19 and health consequences due to such exposure or infection. These risks are unavoidable and I or the Minor may contract COVID-19, including because of negligence of any person or otherwise. I understand that I cannot be guaranteed that I or Minor will not contract COVID-19 through participation in the Event. I agree and promise to accept and assume all of the risks associated with COVID-19 through Minor’s participation in the Event. I hereby certify that I am the parent or legal guardian of the camper. I hereby give permission to the staff of the league to seek during the period of the league appropriate medical attention for the player and for medical attention to be given and for the player to receive medical attention in the event of accident, injury, or illness. I will be responsible for any and all costs of medical attention and treatment, except for that covered by the league's limited secondary medical coverage policy. I for myself and as guardian of the player understand that basketball is an active, physical sport, and that injuries can take place during play. I understand that, as with any sport, injuries can occur, and we hereby acknowledge that our child is physically fit and mentally capable of participating in basketball and league activities. I represent that I have sought the opinion of our child’s pediatrician and he/she concurs that the player is fully capable of safely engaging in these activities. I for myself, our heirs, executors and administrators, waive, release and forever discharge the JL Hoops Factory Camps and its staff, officers, agents, employees, representatives, successors and assign of and from all rights and claims for damages, injury, or loss to person or property which may be sustained or occur during participation in league activities or while at league, whether or not damages, injury, or loss is due to negligence. Do you accept the above terms? Total $0.00 Credit CardCard Details Cardholder Name NameThis field is for validation purposes and should be left unchanged.